27 novembre 2006

Researchers call for critical review, especially of prescribing to babies and young children

Sixty per cent of doctors’ surgeries in Scotland prescribe homeopathic or herbal remedies, according to a study of nearly two million patients, published in the December issue of the British Journal of Clinical Pharmacology.

Researchers from the University of Aberdeen analysed official prescribing data from 2003-4, covering 1.9 million patients from 323 practices.

Their findings have led them to call for a critical review of homeopathic and herbal prescribing in the UK National Health Service, particularly the high levels given to babies and children under 16.

The research team discovered that:

49 per cent of practices prescribed a total of 193 different homeopathic remedies and 32 per cent prescribed 17 different herbal remedies.

Five per cent of the practices included in the study prescribed 50 per cent of the remedies and accounted for 46 per cent of the patients receiving them.

4160 patients (2.2 per 1000 registered patients) were prescribed at least one homeopathic remedy during the study period. 73 per cent were female and the average age of patients was 47.

Children under 12 months were most likely to be prescribed a homeopathic or herbal remedy (9.5 per 1000 children in that age group), followed by adults aged 81-90 (4.5 per 1000). 16 per cent of homeopathic prescribing was to children under 16.

361 patients were prescribed at least one herbal remedy during the study period (0.2 per 1000 registered patients) and 12 per cent of these were children under 16 years old. 72 per cent of prescriptions were issued to females and the average age was 61.

Doctors who prescribed patients a homeopathic remedy also prescribed them a median of four conventional medicines during the study period. This figure went up to five for people prescribed herbal remedies.

Four per cent of patients prescribed a herbal remedy were, at the same time, prescribed conventional medication that has been documented to interact with herbal treatments.

“Our study shows that a substantial number of Scottish family doctors prescribe homeopathic and herbal remedies” says co-author Dr James McLay from the University’s Department of Medicine and Therapeutics.

“This level of prescribing raises important questions about homeopathic and herbal provision in the UK’s National Health Service

“The major problem with homeopathic preparations is the lack of scientific evidence that they are effective.

“Given the rise of evidence-based medicine and the trend toward prescribing guidance in the UK, should therapies with no convincing positive clinical trial evidence be prescribed and funded by the health service"

“Or are proponents of such remedies correct in stating that the difficulties inherent in trialling such therapies make evidence irrelevant.

“Whatever the arguments, our study shows an apparent acceptance of homeopathic and herbal medicine within primary care, including extensive use in children and young babies. We believe that these findings underline the need for a critical review of this prescribing trend.”

“The research by the University of Aberdeen adds an important dimension to the ongoing debate about homeopathic remedies, as it shows what is actually happening at grass roots in Scottish general practice” adds Dr Jeffrey Aronson, Editor-in-Chief of the Journal and Reader in Clinical Pharmacology at Oxford University.

“In September 2006 the Medicines and Healthcare products Regulatory Agency (MHRA) introduced new rules to regulate homeopathic medicines, allowing manufacturers to specify the ailments for which they can be used.

“This move has been criticised by a number of leading UK scientific institutions, who argue that homeopathic medicines should not be allowed to make ‘unsubstantiated health claims’ and that the policy is damaging to patients’ best interests.

“We hope that this paper will further inform the debate, as it provides clear evidence on prescribing patterns within the NHS and raises a number of important issues, particularly about prescribing homeopathic and herbal remedies to children.”